Category Archives: Health Care

Shortage of Health Facilities Inspectors Puts All Virginians at Risk

Regulatory wreck

by James C. Sherlock

I have been the single fiercest public critic of the Virginia Department of Health in general and its Office of Licensure and Certification (OLC) in particular. I have been particularly critical of OLC’s inspections of nursing homes.

We need them to do better, and they agree.

This essay will report what the OLC leadership in response to my FOIA request suggests is required to meet their critical responsibilities.

Their answer is additional staffing and technology, just as reported in an Office of State Inspector General (OSIG) report in 2017.  I dealt with that office more than a decade ago when it was under different leadership and the shortfalls were the same.

The FOIA response indicates to me that the 2017 OSIG report that criticized OSIG staffing and technology shortfalls was utterly ignored.  The OSIG might wish to report on that. Continue reading

Medicaid Enrollment Reaches 1.5 Million Virginians

Annual year-over-year growth of Virginia Medicaid spending and enrollment. Eligibility expanded and provider reimbursements increased at the end of 2018. Source: Senate Finance Committee presentation.

By Steve Haner

Just under two years into Virginia’s Medicaid expansion, and less than one year into a pandemic-sparked economic crisis, enrollment in the program is now about 1.5 million Virginians. Enrollment has grown more than 25% in less than two years and spending more than 30%.

The financial impact on state taxpayers has been blunted by a COVID-19 related boost in the federal share of the program costs, which is expected to continue well into 2021. But the federal legislation providing the money also prohibited the state from removing recipients from the program unless they actually moved away.

The Senate Finance and Appropriations Committee got an update from staff on the Medicaid program at its virtual “retreat” on November 19. Additional information is available from the Medicaid expansion dashboard still maintained by the Department of Medical Assistance Services (DMAS).

Beyond its importance as a very expensive and the fastest-growing state budget element, Medicaid will play a role in two other 2021 stories.  Continue reading

Where Does Ralph Northam Go From Here with COVID-19?

Image by André Santana from Pixabay

by DJ Rippert

Marcel Marceau. Ralph “The COVID Mime” Northam dropped a bevy of increased Coronavirus restrictions on the state last Friday. Those new restrictions on Friday followed another rambling COVID press conference held by Northam the prior Tuesday. Anybody watching the Tuesday news conference could be forgiven for being shocked by The COVID Mime’s actions on Friday. Unlike governors such as Larry Hogan in Maryland Northam avoids any serious discussion of possible actions he might take to slow the spread of the resurgent virus in Virginia during his press conferences. Instead, Northam recites statistics about COVID-19 in Virginia and reminds people to wear masks, maintain social distance and wash their hands regularly. He also provides pithy commentary such as, “This is very concerning, especially because it is getting colder. The holidays are approaching and the temptation to gather with other people is high.” Then, as the news week winds to a close, Northam drops a COVID bomb. To say Jim Bacon was exasperated is putting it mildly. The virus has continued to spread internationally, nationally and in Virginia.  So, we get to play the next installment of the Bacons Rebellion game show “What will The Mime do next?” Continue reading

Biden, Birx and COVID Lockdowns in Virginia

by DJ Rippert

Sine wave. The third wave of COVID-19 has been spreading across the world and has come to America.  As should have been expected it has also come to Virginia. Many European countries have enacted lockdowns that would be considered draconian by most Americans. Several U.S. governors have also dramatically reversed the re-opening of their states’ economies in order to thwart the spread of the virus. Federal infectious disease experts are sounding the alarm. “We are entering the most concerning and most deadly phase of this pandemic . . . leading to increasing mortality,” said the Monday report from Deborah Birx, coordinator of the White House coronavirus task force. Birx predicts that the US will see more than 100,000 new cases per day this week.

In the Old Dominion, as WAVY reported yesterday, “Virginia’s [7-day] daily average of 1,306 cases per day is more than 100 cases per day above previous highs in August and May, mostly spurred by spikes in Southwest Virginia, and a notable increase in Northern Virginia. Virginia’s case incidence rate per 100,000 residents is now 15.3, which is considered especially high.” WAVY further reports that Virginia’s case per day total will reach 2,000 by the end of January per UVa’s COVID-19 model. Meanwhile, our governor is unconcerned, citing historical statistics that prove (to him) that Virginia has no real need for concern.

It seems that the stage is set in Virginia for a set of knee-jerk proclamations that will send our state’s economy back into the tail spin we experienced this spring.

Continue reading

The University of Virginia Eastern Virginia Medical School

by James C. Sherlock

With additional information and thoughts generated by responses to my original posts on this matter, I offer this post as a final proposal before the November 15 release of the Sentara-funded “study” of what I call the Sentara Plan for Eastern Virginia Medical school.

The nation is short of doctors and shorter yet of good doctors. The nation has to produce more of both or the situation projects to worsen.

There is an opportunity here in Virginia to deal with both objectives.

But the Sentara Plan is not it.

Continue reading

UVa Medical School Takeover EVMS – A Real Opportunity for A Lot of Good

by James C. Sherlock

Hampton Roads

I recommend the transformation of healthcare and physician training in the Hampton Roads.

I reject both the presumptions and the terms of the current study of a merger of ODU, EVMS, Norfolk State and Sentara to improve EVMS.

That study is funded by the organizations involved and the outcome is pre-ordained.

But it embarrassingly assesses a combination of some of the poorest performing institutions in Hampton Roads. From that baseline, it cannot possibly offer the best outcomes for the Commonwealth or the people of Hampton Roads. Continue reading

The Strange Case of a Proposed Medical Merger in Hampton Roads

by James C. Sherlock

Hampton Roads

There was a story  Could EVMS merge with ODU, Sentara?” – in the Virginian Pilot this morning. It was well done and rendered a major public service.

A private study is “assessing” a regional merger of Sentara, ODU, EVMS and Norfolk State.  “Its task will be to provide recommendations to Gov. Ralph Northam on new ways the schools and hospital system could combine.” Not whether they should, or if there are any better options. 

The study is paid for by the hopeful merger candidates, so no one will be waiting breathlessly for the findings, except apparently the Governor.  

Northam has already announced that the results “may lead to significant changes for Hampton Roads’ “health care ecosystem,” which serves more than 1 million people.

The whole project reeks of Sentara self interest. The merger being studied will not be optimized for the good of the people of Hampton Roads. 

Sentara wants the state to award it because the merger otherwise cannot withstand federal antitrust review.

Continue reading

Northam’s Non-COVID Non-Update

Note: video starts at 4:50

by DJ Rippert

Northam fiddles. As a resurgence of COVID-19 spreads across Europe and the United States, Virginia Governor Ralph Northam held a press conference ostensibly to discuss the pandemic. The presser provided little new information about the coronavirus or Virginia’s plans to combat the disease. Northam did review statistics from the five health regions around the state but failed to provide any new guidance for Southwest Virginia where cases are spiking and the positivity rate has reached 8%. Northam’s useful advice was to wear masks, maintain social distance and wash your hands regularly. Continue reading

Does Northam Have a Plan to Battle a COVID Resurgence in Virginia?

Image by Gerd Altmann from Pixabay

by DJ Rippert

The second (or third) time around. America’s polarized political situation has all eyes on the upcoming presidential election. Millions are voting early and millions more will vote by mail. There is a good chance that the final results will not be known on the morning after Election Day. If true, America’s attention will be riveted on the election through November and quite possibly into December. Meanwhile, COVID cases are surging in the U.S. and parts of Europe. Yesterday, the U.S. recorded 906 COVID-related deaths. That number had been averaging between 700 and 800 since early autumn. Virginia’s record in managing COVID has been mediocre to date. Not terrible but not great either. The state ranks 30th in per capita COVID-related deaths. Over the last seven days Virginia has recorded the 21st most cases of COVID among U.S. states. As evidence of a resurgence of COVID mounts, Virginians ought to wonder whether the state is ready to react to such a resurgence if it occurs.

Continue reading

Why We Love Governor Ralph

Governor Northam loving those poll numbers. Photo credit: Richmond Times-Dispatch

By Peter Galuszka

He’s been through “coonman,” “blackface,” a muddled interview about late term abortion, and aggressive and controversial steps to stop the pandemic, but Democratic Gov. Ralph Northam has sprinted through a recent statewide poll with flying colors.

According to a new Washington Post-Schar School poll, more than half of Virginia’s registered voters approve of the overall job performance of Gov. Ralph Northam, and an even larger majority support his handling of the novel coronavirus pandemic. “Northam’s job approval rating of 56 percent is up from 49 percent about a year ago and from 43 percent in the wake of his blackface scandal in early 2019, “The Post said.

“His disapproval is also up, at 38 percent from 31 percent last year, with far fewer voters now expressing no opinion. But his ratings remain net positive by 18 percentage points.”

The Governor gets a drubbing on this blog, but not with people who really count, given their numbers. Continue reading

Health Enterprise Zones for Virginia

by James C. Sherlock

Image credit: Gordon Johnson

COVID-19 exposed what many already knew: Poor people suffer broad disparities in health outcomes when compared to their wealthier counterparts. 

In my original post on health care legislative initiatives in the 2021 General Assembly Session, I recommended the establishment of Health Enterprise Zones.

That initiative seeks reduction of health disparities among Virginia’s poor and among geographic areas, improvements health care access and health outcomes in underserved communities and reductions of health care costs and hospital admissions and re-admissions.

The Health Enterprise Zone (HEZ) initiative has been proven to work in Maryland and New Jersey.  

The Maryland results have been spectacular. And  in Maryland the zones have proven net positive for the state budget.

Continue reading

A Measured Consequence: More Heavy Drinking

by Carol J.Bova

Yesterday, Jim Bacon wrote about “the unmeasured consequences of society’s reaction to the COVID-19 epidemic.” The RAND Corporation COVID-19 Update on October 8, 2020 provided a reference to a longitudinal survey that examined one of those consequences — alcohol usage.

JAMA Network Open published a Research Letter, “Changes in Adult Alcohol Use and Consequences during the COVID-19 Pandemic in the US” by Michael S. Pollard, PhD and Joan S. Tucker, PhD, RAND Corporation, Santa Monica, California; and Harold Green, Jr. PhD, Indiana University School of Public Health, Bloomington, Indiana.

The survey study data, collected from May 28 to June 16, 2020, found the frequency of alcohol consumption overall increased 14% over a baseline survey from April 29 to June 9, 2019.

Heavy drinking was defined as five or more drinks for men and four or more for women within a couple of hours. For women in the study, the increase was 17% and “the Short Inventory of Problems scale” showed a 39% increase, “which is indicative of increased alcohol-related problems independent of consumption for nearly 1 in 10 women.” Continue reading

Virginia: 4,500 “Excess” Deaths This Year, Only Half from COVID-19

by James A. Bacon

It’s good to see that the left-leaning Virginia Mercury making the same observation as Bacon’s Rebellion about the unmeasured consequences of society’s reaction to the COVID-19 epidemic. Research from Virginia Commonwealth University shows than an additional 4,500 Virginians died between March and August over the number that would have been predicted from past years’ experience. Continue reading

A Broad Healthcare Agenda for the 2021 General Assembly

Towards a Better, Freer, Less Expensive and More Accessible Healthcare System in Virginia

Image credit: Gordon Johnson

by James C. Sherlock

COVID-19 exposed weaknesses in Virginia’s healthcare delivery system in both readiness and equity of access.

Even before COVID, we have been dealing for decades with the costs of all kinds imposed by Virginia’s unregulated regional healthcare monopolies. The General Assembly has an opportunity, even in this upcoming non-budget year, to deal with them in ways that also save money in Medicaid.

The Certificate of Public Need (COPN) law passed in 1973 gave the Virginia Department of Health (VDH) control over the construction and expansion of new hospitals, ambulatory care and diagnostic imagery centers and of the equipment necessary to operate them. Every effort to break the monopolies it has created or repeal the law has failed. 

We see the results of nearly 50 years of this law in the extraordinarily high costs of healthcare in Virginia, the profound unreadiness of the Virginia healthcare system for COVID and the disproportionate impact of COVID on Virginia’s poor.

It is time to stop pursuing COPN repeal and move forward with reform. 

I will offer here a broad program to update Virginia law to control costs and improve access without repeal of COPN. Each of the reforms start with the assumptions that we have regional healthcare monopolies and they are not going away and that COPN is not going to be repealed. Reform will have to work around those facts. Continue reading

778 Virginia Hospital Patients Discharged to Nursing Homes

Source: “COVID Utilization and Hospitalization Trends,” PowerPoint presentation by David Vaamonde, vice president-data analytics.

by James A. Bacon

A large majority of the patients treated for COIVD-19 and released from a Virginia hospital between April and June this year went directly home. But a significant number — 778 — were transferred to a “skilled nursing facility,” according to data contained in a Virginia Hospital and Health Care Association webinar delivered yesterday.

That raises a question. What were the protocols for discharging and transferring patients to nursing homes? What assurances were there that transferred patients were no longer infectious?

(Update: A commenter suggests that I may be improperly conflating “skilled nursing facilities” with “nursing homes,” so the reality may be more complicated than I have portrayed in this post.)

We know that an order by New York Governor Andrew Cuomo compelled hospitals to release elderly COVID patients into nursing homes early in the epidemic, resulting in a catastrophic spread of the disease among the state’s elderly. I know of no such order given by Governor Ralph Northam, and it is entirely possible that none of the patients released to long-term care facilities were infected. I’m simply asking the question. Continue reading